Depression

Studies have shown that prevalence of depression in primary care settings ranges from 4.8-8.6% with more than half of these patients being undetected and/or under-managed. This epidemi-ological work demonstrated a clear need for increasing access to depression treatments through primary care settings. Following these studies, we observed population receiving treatment for depression in outpatient settings. This treatment trend coincided with the growth of managed care and concomitant cost-containment policies shifting treatment of depression from mental health specialty settings into primary care settings, practical tools for assessing and diagnosing depression in clinical settings, and the availability of second and third generation antidepressant medications which were easier to use in the medical setting because of their quicker response and less severe side effect profiles. Furthermore, efficacious forms of counseling eg, cognitive-behavioral and interpersonal therapies that are structured and time-limited became more available, including brief forms of therapy that could be delivered within the medical setting. National guidelines for the effective treatment of depression in primary care settings led to quality improvement efforts made by health care organizations and providers working within them and a number of successful randomized trials have shown that dissemination of evidence-based guidelines to providers in a variety of practice settings can have positive effects on the processes and outcomes of care for depression. Depression has escaped from Pandora's box and is now being viewed on par with other medical chronic illnesses.